When should we hire a Aging Life Care Manager?


·      When there’s no local support system in place or family lives too far away to assist regularly.
·      Family members are unable to determine needs, agree on options, arrange for or oversee care.
·      If the burden of providing care is threatening the health of the spouse or primary caregiver.
·      When placement in a facility is necessary and your not sure what fits both care needs and budget.
·      Your loved one displays inappropriate behavior, uses poor judgment or may be easily victimized.
If you’re experiencing any of these or other concerns, call Advanced Senior Solutions. 727-443-2273 www.advsrs.com

Not All Aging Life Care Managers Are Created Equal

Aging Life Care Management is a rapidly developing, newly recognized profession which helps families adjust and cope with the challenges of an aging loved one.

Aging Life  Care Manager’s  are health advocates for seniors and disabled adults. Managers  provide needs assessments, screening, arranging, and monitoring in-home help, counseling and support including family conflict mediation and crisis intervention. They assess the ability to remain safely in the home or whether the person may need to be relocated to an alternative residence. Determining appropriate living arrangements and necessary supportive assistance are among the many services they offer. Additionally, managers’s help to facilitate legal, financial, medical and end of life services.

Aging Life Care Managers become liaisons to families who are separated by long distances from their elderly loved ones making sure they are managing well,
and alerting them to any concerns or problems that may arise. Managers’s have extensive knowledge about the services and resources in their communities.

Aging Life  Care Managers hold Bachelor Degrees, Masters Degrees, or Doctorates in a human service related field such as Gerontology, Social Work, Psychology, or Nursing. As the aging
population continues to grow, the need for strict Aging Life Care standards is increasingly critical.

The National Association of Aging Life Care Managers recognizes the following credentials as exceeding the standard of expertise in being a Aging Life Care Manager;
CMC, CCM, A-CSW & C-SWCM. The certification exam to be a CMC is facilitated by the National Association of Certified Care Managers (NACCM). These certifications re-quire testing, ongoing continuing education and peer review in order to re-certify.

Because there are some individuals working either independently or for a different professional and who refer to themselves as “Care Managers”, it is important for the wise consumer to ask questions when considering hiring a PCM. Some of these questions include:

How much experience does Aging Life CareManager have in healthcare?

  • What are the credentials and education of the Aging Life Care Manager?
  • Are they Licensed, Bonded and Insured? Ask to see it
  • Are they a member of the National and State Associations of Aging Life C are Care Managers?
  • What types of services do they offer?
  • Can they provide references from clients/families?
  • What are the fees and costs for services? Do they offer a complimentary consultation?

When selecting either a Professional Care Management Agency or an Individual, the process should be comprehensive and cautious. The answers to your questions will assist you in
determining whether that particular Agency or Sole Proprietor has the qualifications important to you for a successful relationship.

Ten questions to ask when hiring a private home care agency

1. What is the background of your company? Search out the history and ownership of the company. Find out who owns the company and weigh how the ownership affects the company’s service and reliability. is it reputable and in good standing?

2. How long has your company been in business? The number of years an agency has been in business is not always pertinent to the quality of care given,\ but it does reflect on the stability and success of the company.

3. What qualifications, certifications, experience and training do you require of your workers? Find out if caregivers’ credentials are investigated. Plus, determine whether caregivers undergo a thorough, professional testing and screening process.

4. Are your employees insured and bonded? For your protection, ensure that all caregivers are insured and bonded by the home care agency.

5. How do you supervise your workers to make sure the proper care is given? Some agencies make scheduled quality assurance calls and visits. To further ensure quality care, see that all caregivers are regularly and closely supervised by a qualified company representative.

6. Will the same employee continue with my case? It is difficult to receive good care if different people show up every week. A good home care provider will be concerned with continuity of care.

7. Do you conduct a home visit before starting the home care service? It is important that the patient and family members discuss the kind of care needed with a home care representative. This will help you determine whether the home care provider can meet your needs.

8. Do you work with my doctor in developing a plan of care? If you require care beyond that associated with activities of daily living, your doctor ought to be involved.

9. Can you give me some references from doctors, hospital personnel or social workers? Ask for names of people, not just the name of a hospital or organization.

10. Do you guarantee customer satisfaction? Find out if you’re locked in to a contract for a certain period of time. The home care provider should guarantee care and cancel charges for unsatisfactory service.

By Lory Smeltzer, MPH, CMC

Supervising Activities

People who are getting agitated can sometimes feel better if they have something useful or interesting to do. However, they usually need direction to find appropriate activities and to prevent frustration. Here are some suggestions that can help:

Structure and routine. Try to follow regular predictable routines that include pleasant, familiar activities. Remind the person that everything is going according to plan.
Pleasant activities. Make time for simple pleasant activities the person knows and enjoys—listening to music, watching a movie or sporting event, sorting coins, playing simple card games, walking the dog, or dancing can all make a big difference.
Keep things simple. Break down complex tasks into many small, simple steps that the person can handle (e.g., stirring a pot while dinner is being prepared; folding towels while doing the laundry). Allow time for frequent rests.
Redirect. Sometimes the simplest way to deal with agitated behavior is to get the person to do something else as a substitute. For example, a person who is restless and fidgety can be asked to sweep, dust, rake, fold clothes, or take a walk with the caregiver. Someone who is rummaging can be given a collection of items to sort and arrange.
Distract. Sometimes it is enough to offer a snack or put on a favorite videotape or some familiar music to interrupt behaviors that are becoming difficult.
Be flexible. Your loved one might want to do some activity or behave in a way that at first troubles you, or may refuse to do something you have planned, like taking a bath. Before trying to interfere with a particular behavior, it is important to ask yourself if it is important to do so. Even if the behavior is bizarre, it may not be a problem, especially in the privacy of your own home.
Soothe. When the person is agitated, it may help to do simple, repetitive activities such as massage, hair-brushing, or giving a manicure.
Compensate. Help the person with tasks that are too demanding. Don’t put the person in a position where demands will be made that he or she cannot handle.
Reassure. Let the person know that you are there and will keep him or her safe. Try to understand that fear and insecurity are the reasons the person may “shadow” you around and ask for constant reassurance.

Getting to doctor appointments. Is the person upset about going to the doctor or dentist? Here are some helpful hints: Emphasize the value of a check-up, rather than a test for a specific problem.

Providing the right environment

It is important to evaluate the person’s environment—his or her bedroom, daytime areas, and schedule—to see if any of the following problems may be contributing to agitation:

  • Some individuals become particularly agitated at specific times of the day. Would it help to change the person’s routine to avoid these problems? It is helpful to try to do things in the same place at the same time each day.
  • Agitation may result from thirst or hunger. If a person with dementia forgets to eat, offer frequent snacks and beverages.
  • Agitation may result from physical discomfort. Has the person remembered to use the bathroom? Is he or she constipated? Could there be aches and pains from sitting in one place?
  • Does the person have a regular, predictable routine? Unexpected changes or last minute rushing can cause those with dementia to become scared and disoriented.
  • Getting dressed can be frustrating for someone with dementia. Try to simplify this task, for example, by using Velcro fasteners and not insisting on matched outfits.
  • Is the person feeling rushed, overwhelmed, hungry, tired, scared, constipated, cold, or hot? Does he or she need to use the bathroom? Fresh air or air conditioning can minimize agitation. It is also important not to rush individuals with dementia. Simplify dressing by using Velcro fasteners. Don’t insist on matched outfits.
  • Is there a chance for regular exercise? Walks and simple exercises are good ideas. If a person wants to pace and isn’t disrupting anyone, that’s OK, too.
  • Is the room well lighted? Good lighting can help to reduce disorientation and confusion. Provide night-lights.
  • Is the air temperature comfortable? Try to provide fresh air, heating, or air conditioning as needed.
  • Is the environment too noisy or confusing? Are there too many people around? It may be helpful to use picture cues, to personalize the room, and to decorate and highlight important areas with bright contrasting colors.

Is the environment safe? If not, take the necessary steps to ensure the safety of the patient and caregiver (e.g

Learning how to talk to a person with dementia

People with dementia often find it hard to remember the meaning of words that you are using, or to think of the words they want to say. You may both become frustrated. The following tips can help you communicate more effectively with a person who has dementia:

  • It is understandable that you may feel angry; but showing your anger can make the agitation worse. If you are about to lose you temper try “counting to ten,” remembering that the person has a disease and is not deliberately trying to make things difficult for you.

Try and talk about feelings rather than arguing over facts. For example, if the person with dementia is mistakenly convinced you didn’t see him yesterday, focus on his feelings of insecurity today: “I won’t forget you.”

  • Identify yourself by name and call the person by name. The person may not always remember who you are; don’t ask “Don’t you remember me?”
  • Approach the person slowly from the front and give him or her time to get used to your presence. Maintain eye contact. A gentle touch may help.
  • Try to talk in a quiet place without too much background noise such as a television or other people in conversation.
  • Speak slowly and distinctly. Use familiar words and short sentences.
  • Keep things positive. Offer positive choices like “Let’s go out now,” or “Would you like to wear your red or blue cap?”
  • If the person seems frustrated and you don’t know what he or she wants, try to ask simple questions that can be answered with yes or no or one-word answers.
  • Use gestures, visual cues, and verbal prompts to help. For example, if suggesting a walk, get out the coats, open the door, and say “Time for a walk.” Set up needed supplies in advance for tasks such as bathing and getting dressed; have a special signal for needing to go to the bathroom. Try to break up complicated tasks into simple segments; physically start doing what you want to happen.
  • If a subject of conversation makes a person more agitated or frustrated, it may help more if you drop the issue rather than keep on trying to correct a specific misunderstanding. He or she will probably forget the issue and be able to relax in a short while.

Exercise and Chronic Disease

Contrary to traditional thinking, regular exercise helps, not hurts, most older adults. Older people become sick or disabled more often from not exercising than from exercising. Those who have chronic disease or health problems may actually improve with regular exercise, but they should check with a physician before increasing their physical activity.

There are few reasons to keep older adults from increasing their physical activity, and being “too old” and “too frail” aren’t among them. Almost all older adults, regardless of age or condition, can safely improve their health and independence through exercise and physical activity.

Is It Safe for Me to Exercise?

Most older people think in terms of getting their physician’s approval to start exercising, and that’s always a good idea. A physician can talk to seniors about the benefits of exercise and suggest an appropriate exercise program.

Chronic Diseases: Not Necessarily a Barrier to Exercise

Chronic diseases are illnesses that can’t be cured but usually can be controlled with medications and other treatments. They are common among older adults and include diabetes, cardiovascular disease (such as high blood pressure), and arthritis.

Traditionally, exercise has been discouraged in people with certain chronic conditions. But researchers have found that, in many older people, exercise can actually improve certain chronic conditions, as long as it’s done during periods when the condition is under control.
If the person in your care has a chronic condition, you are probably asking yourself how you can tell whether their disease is stable. How do you know if exercise would be beneficial or harmful for the elderly person?

Get a Physician’s Advice

When to Check with a Physician
Before starting an exercise program, or increasing physical activity, check with a physician if:
  • You have a chronic disease ? for example, heart disease or diabetes.
  • You have a family history of chronic disease.
  • You have other factors which put you at high risk for certain health problems (for example, if you smoke or are obese).

The physician can recommend a suitable exercise regimen, or refer the senior to a qualified professional who can customize an exercise program for them.

A physician can also inform the senior of symptoms that may mean trouble ? a flare-up, or an acute phase or exacerbation of the disease. For example, if the person you are caring for has congestive heart failure (CHF), the acute phase of this disease should be taken seriously. A CHF patient should not exercise when warning symptoms of the acute phase, or any other chronic disease, appear. It could be dangerous. When they are free of these symptoms ? in other words, stable or under control ? this is the time to exercise.

Other circumstances require caution, too. Nobody should exercise until checking with a doctor if they have:

  • Any new, undiagnosed symptoms.
  • Chest pain.
  • Irregular, rapid, or fluttery heartbeat.
  • Severe shortness of breath.
  • Significant, ongoing weight loss that hasn’t been diagnosed.
  • Infections, such as pneumonia, accompanied by fever.
  • Fever itself, which can cause dehydration and a rapid heartbeat.
  • Acute deep-vein thrombosis (blood clot).
  • A hernia that is causing symptoms.
  • Foot or ankle sores that won’t heal.
  • Joint swelling.
  • Persistent pain or a disturbance in walking after a fall; there might be an undiagnosed fracture and exercise could cause further injury.
  • If certain eye conditions are present, such as bleeding in the retina or detached retina; or if there has been a cataract or lens implant, laser treatment, or other eye surgery.

Men over 40, and women over 50 should check with a doctor first if they plan to do vigorous, as opposed to moderate, physical activities. Vigorous activity could be a problem for people who have “hidden” heart disease (some people have a heart disease, but are unaware because there are no symptoms).

How can you tell if the activity planned is vigorous? An activity that causes you to breath and sweat heavily is considered vigorous. Keep in mind people have varying levels of fitness. Running is a vigorous activity for some people, but for others, walking is as vigorous. It depends on the individual’s physical and medical condition.

Exercise Can Enhance Rehabilitation After a Heart Attack

If the person you are caring for recently had a heart attack, the physician or cardiac rehabilitation therapist should have assigned specific exercises to do after being discharged from the hospital or as part of a cardiac rehabilitation program. Research has shown that exercise done as part of a cardiac rehabilitation program can improve fitness and reduce the risk of dying. If the senior didn’t get instructions before leaving the hospital, make sure they call the physician to discuss exercise before increasing physical activity.

When Exercise Is a Bad Idea

For some conditions, vigorous exercise is dangerous and should not be done, even in the absence of symptoms. Check with a physician before beginning an exercise program if you have either of the following conditions:

  • Abdominal aortic aneurysm, a weakness in the wall of the heart’s major outgoing artery (unless it has been surgically repaired or is so small that your doctor tells you that you can exercise vigorously.)
  • Critical aortic stenosis, a narrowing of one of the valves of the heart.


How to Tell When It’s Time for Professional Home Health Care

As they grow older, most people want to continue living independently in their own homes. They want to remain self-sufficient in their familiar surroundings. That’s certainly expected and natural. But all too often the very fact of aging affects people’s ability to care for themselves and manage their daily living, and this creates health and safety concerns. Many adult children become their parents’ primary caregivers, taking on all the responsibilities that go with keeping up the quality of their parents’ lives. When caring for themselves becomes progressively too difficult, or when the responsibilities of the adult children become overwhelming, it is time for both seniors and their families to consider professional home health care.

Here Are 20 Signs That Signal the Need for Professional Home Health Care:Inability to manage personal care:

  1. The person does not bathe, groom, and perform oral hygiene.
  2. The person does not dress appropriately.
  3. He or she becomes incontinent and is unable to cleanse properly.
  4. The person forgets to eat, does not eat nutritious meals, and loses weight.
  5. He or she forgets to take medication, is confused about what to take and when, or is unable to administer injections or change bandages.
    Inability to manage functional activities of daily living:
  6. The person doesn’t do laundry, or doesn’t change his or her clothes or linen.
  7. He or she lets dirty dishes and garbage pile up.
  8. The person leaves the stove and other appliances on, creating a safety hazard.
  9. He or she is unable to do grocery shopping.
  10. He or she is unable to use the telephone.
  11. The person doesn’t pay bills or manage money properly.
    Change in emotional, mental or physical condition:
  12. The person has difficulty understanding others.
  13. The person has difficulty remembering names, situations, and locations.
  14. He or she gets lost easily.
  15. The person starts to wander.
  16. The person has sudden mood swings, becoming angry or depressed.
  17. He or she falls down often.
  18. He or she becomes isolated, cutting off social contacts.
  19. The person is incapable of making decisions.
  20. He or she suffers a stroke, loss of limb, or other major physical impairment.

Patient Care Advocacy Organizations

State and Private Agencies Investigate Complaints of Poor Treatment

What if you are not satisfied with the quality of care?

One of the most difficult challenges for caregivers occurs when problems arise with the facility or heath care professionals who are supposed to help the senior. If you are not satisfied with the quality of care, discuss your concerns with the facility’s director. You might also want to speak with the senior’s physician, facility medical director or other appropriate staff member.
Misunderstandings rather than poor intentions cause many problems, and talking with staff and managers can frequently resolve them. Moreover, federal and state laws require facilities to investigate complaints about treatment. However, if directly approaching those involved does not produce results, you may have to turn to one or more advocacy organizations. These include:

·          Ombudsman programs, which investigate complaints against long-term care facilities
·          Peer review organizations (PROs), which oversee quality of care for Medicare patients
·          State survey agencies, which conduct reviews of nursing homes
·          Professional licensing boards, which can sanction their members
·          Law enforcement agencies, which can investigate criminal activities

Ombudsman Programs

If you have a complaint about a nursing home or other facility you cannot resolve with the staff, try the local ombudsman program. Ombudsman programs are independent nonprofit agencies mandated by law to protect the rights of residents in long-term care facilities and investigate complaints. Every state has an ombudsman program; most of the programs maintain local branches in different parts of the state.

State and federal laws require facilities to post contact information for the ombudsman program in their area. Ombudsmen can meet with residents and their caregivers and families to discuss quality of care, financial issues, dietary matters and other areas of concern. Ombudsmen can also mediate disputes between facilities and residents or their representatives.

Ombudsmen have no enforcement authority. However, ombudsmen refer their findings to the state survey agency, which is mandated to regulate nursing homes. Since neither the facility nor the state employs them, their recommendations carry special weight with state survey agencies.

Peer Review Organizations

If you have a complaint about a doctor, hospital, managed care plan or nursing home that you cannot resolve with that physician or organization, try contacting your state’s Peer Review Organization. These organizations — also known as Quality Improvement Organizations — investigate complaints about any care a patient has received under Medicare.However, like ombudsmen, they have no enforcement authority. If enforcement is necessary, the PRO may refer a complaint to the state survey agency or the relevant licensing board.

State Survey Agencies

If neither the ombudsmen nor the PRO is able to help you, you can turn to the state survey agency, also sometimes known as a state licensing agency. These agencies enforce federal guidelines regulating nursing homes and have the power to issue sanctions and impose penalties against facilities with substandard practices.

The possible penalties vary widely, from monetary fines to bringing in a temporary management team to even — although this is rare — closing down a facility. These agencies also conduct annual inspections of every Medicare- or Medicaid-certified nursing home.

Professional Licensing Boards

If your complaint is with a nursing home, the state survey agency has enforcement authority; however, if your complaint is with a physician, nurse or hospital, you can turn to the professional licensing board. The boards oversee standards for medical professionals and facilities and can exercise disciplinary authority if necessary.

For example, physicians are licensed through a state board of medical examiners which can sanction them or revoke their medical licenses; nurses are licensed through a state board of nursing, and most hospitals undergo accreditation through the Joint Commission on the Accreditation of Hospital Organizations. You can find phone numbers in the state government section of your telephone book.

Law Enforcement Agencies

If you have a complaint about a facility or care provider that is so serious you believe a law has been broken, you should call a law enforcement agency. These agencies have responsibility in cases of criminal misconduct. For example, a licensed medical professional who steals a patient’s pain medication could face both malpractice and criminal charges. Licensing boards deal only with the professional licenses, so the state’s attorney general or the local police would investigate a possible criminal violation.

In serious or life-threatening situations, such as physical or sexual abuse, any individual can call the local police department, the city attorney’s office or the state’s attorney general. You can find the numbers in the government section of your telephone book.

Unhappy With a Nursing Home? Considering a Move?

Despite all your best efforts, you may find that a senior you care for is in a nursing home that is not meeting your expectations. What do you do? This article examines the questions about when, and how, to choose a new nursing home.
Admitting someone in your care to a nursing home may be one of the most emotionally traumatic things you ever do. You and the senior will go through an adjustment period that may last several weeks before you reach some sort of equilibrium.
The same thing happens to all of us when our social situation changes. If you think back in your life you may remember starting school, moving away to college, or starting a new job. You may also remember advice you received from your parents and later gave to your children, such as “stick with it,” or “You don’t want to be a quitter.”
It is also important to recognize that situations where everyone is happy are rare. Be realistic in your expectations. For example, you must have a quality facility that treats people with dignity; but don’t expect rave reviews from the senior. For most people, being in a nursing home is what they had feared and hoped to avoid.

Beware of Judging the Facility Based on Traumatic Reaction to the Move

With that in mind, remember to “Stick with it.” Especially in the beginning, there will most likely be a traumatic initial adjustment to even the best facility. So don’t make the mistake of evaluating a nursing home based on your own emotional state rather than an honest appraisal of the care and attention the senior is receiving. Remember that building a relationship with the staff of the new facility is the best way to assure that they understand the needs of the senior and for you to get timely, honest information back. Also, bear in mind that staff in a nursing home work efficiently because of routines and standardization. This means they may not provide care exactly the way you do. In fact, they probably cannot provide care the way you do.

Keep the Senior Involved in the Decision Making Process

However, there are times when an honest appraisal of your situation demands that you seriously consider moving the senior to a new facility. As we explore this idea we will look at some of the issues and even warning signs that indicate you should consider a change. We will also discuss the down side of moving and the effects that a change may have on the senior. All in all, the placement decision should be dictated by what is in the senior’s best interest, and should be made by those who are most qualified to understand and interpret his wishes. The senior should always be kept informed and involved in the decision-making process unless a physical or mental condition precludes it.
The best advice, of course, is to carefully select the right nursing home for the initial placement. But, even if you did all your homework, some placements may not be permanent for a variety of reasons. What are some valid reasons to consider a move, and how do you go about arranging it?

Improvement in Condition Is a Good Reason to Move

The most positive reason for changing placements is that the senior improves in health to a point that certain skilled services are no longer needed. Many more people enter nursing homes for rehabilitation today than just a few years ago. Many, if not most, placements are seen as temporary because of a physical condition such as a stroke or fracture.

Medical Concerns and Uncaring Staff Can Be Reasons to Move

Of the negative reasons to change placements, quality of care is the most important. Medical signs that are the most telling include:
  • Significant weight loss
  • Dehydration
  • Bedsores
However, you should ask to discuss your concerns with the director of nurses before drawing conclusions since there may be a valid medical reason for all of these conditions becoming unavoidable. You might want to back this up by discussing it with the physician or facility medical director. Other questions you want to ask yourself and the senior include:
  • Does the senior feel comfortable discussing concerns with the staff?
  • Are management staff receptive to your concerns?
  • Do the staff, in general, seem to care about the senior?
Remember, one employee doesn’t represent the whole facility. Report any behavior that does not meet your expectations.

Moving Can Be Traumatic; Try Every Reasonable Way to Resolve the Problem First

Stability is important for a senior’s sense of well being. When a problem comes up, consider whether you are dealing with a minor annoyance or a real issue. Communicate your concern to a management level person and give them a chance to explain or resolve it. Do what you can reasonably do to try to avoid moving the senior.
The potential burdens of relocation include relocation trauma, which in some cases may be fatal to a frail elderly person, especially someone who has been in one location for a long time or is significantly confused. The very frail do not have the inner reserves to handle physical or emotional stress as well as they did when they were healthier. All moves, even those carefully planned for very good reasons, entail a certain amount of stress. As many as 10 percent of people moved from a skilled care facility will die from a range of causes which can include depression, loss of appetite, and onset of pneumonia.
Another, much less severe side effect of relocation is simply that you and your senior will experience another adjustment period in the new facility. There are times, however, when the potential benefits outweigh the risks.

Moving Will Require Coordination; the Current Facility Should Help You

If, after careful consideration, you and the senior decide it is necessary to move, how do you go about it? The process of relocating is as simple as notifying the current facility that you wish to move. Nursing homes are obligated to assist you in the relocation process, which is usually handled through the social services director.
The amount and kind of help the nursing home provides can vary significantly, depending on your needs and the senior’s needs. You may wish to choose the new facility yourself; however, the discharge planner can also make all the calls and find a suitable new placement. Bear in mind that if the senior entered the current facility as a self-paying resident and converted to Medicaid while there, in searching for a new facility, you will be limited to those which accept Medicaid. The discharge planner can also arrange for an ambulance to move your senior, if necessary, and for someone to pack up and move personal possessions.
When and if you decide to change nursing homes you should be as thorough in your search for a new home as you were in your original search. Involve the senior in the decision-making process and make the move if it is in her best interest.